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PUBLIC RECORD OFFICE

Reference :-

C.O.885

21 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH~NOT TU

2.12

coolie ships with either or both of these They are unable to affirm that the treat- drugs?

ment would be effective. They would suggest that the cases requiring treat- ment should be selected in the Calcutta depôts, by the depôt staff, previous to embarkation, and a list supplied to the surgeon. They would then endeavour to treat as many as possible during the voyage. They believe that it would not be necessary to employ a medically quali fied man to make the examinations in the depôts. A native compounder with a knowledge of microscopic work would be sufficient.

I have, &c.,

Enclosure 2 in No. 130.

W. K. MILEY,

Hon. Secretary.

Note. For convenience of reference we have made at the end of this letter a summary of its contents. GENTLEMEN,

London, June, 1913.

I HAVE the honour to inform you that at the meeting of Surgeons-Superinten- dent held on 11th June 1913, I submitted for consideration your letter M/Coolies, May 15th 1913, together with the letter (copy) from the Secretary of State for the Colonies to you-12657/1913, dated 6 May 1913-with its enclosures (copies), relating to the proposal to treat coolies for ankylostomes during the voyages to British Guiana and Jamaica.

The meeting has asked me-the Honorary Secretary to convey to you the results of its consideration of this question, and this I have now the honour of doing. We (the Surgeons-Superintendent) gave careful consideration to those papers but could find no cause in them for altering our previously expressed opinion

that it is inexpedient to apply compulsory routine treatment on coolie ships.

3. In 1911 the Surgeon's Committee drafted a reply to the despatch addressed to the Secretary of State for the Colonies by the Governor of British Guiana (Sir F. M. Hodgson)-British Guiana No. 322 dated 4th October 1910-and to the minutes of the Acting Surgeon General (Dr. Law) and the Agent-General for Immi- gration (Mr. Duff) which accompanied that despatch. Before that reply was ready for forwarding the Committee learned of the retirement of His Excellency and also of Dr. Law and Mr. Duff. In these circumstances the Committee did not think it necessary to send the letter in.

Now that the question has been revived, and as that letter bears on it, we beg to forward it herewith.

We would direct special attention to the following points connected with

this question :-

(a) the risks involved in compulsory indiscriminate treatment;

(b) the absence of proof of the efficiency of such treatment on board ship;

5. In our Committee's letter these points are dealt with at some length; but

in further support of our views as to the risks involved we quote from one of the most recent authorities-Castellani and Chalmers' Manual of Tropic Diseases,-Edition 1910. In dealing with the administration of thymol they say :—

"In all cases the patient should be carefully examined as to the condition of his organs before treatment is begun and he should be placed on low or liquid diet for a day or so and while being treated should be kept in bed thymol is a very poisonous drug in large doses, causing first irritation of the cerebral centres with excitement and vertigo. larger doses, the nerve centres are paralysed, blood pressure falls and the patient dies of collapse. Thymol is very insoluble in water, but easily soluble in alcohol, ether, chloroform, glycerine and turpentine; hence no stimulant

213

whatever must be given to a patient who is to take or who has taken thymol Thymol is also soluble in oil; hence no purgative of castor oil should be given after its administration

beta naphthol can be

given in 15 grain doses in the same manner as thymol same precautions as with thymol."

with the

6. Now castor oil is one of the most useful and most frequently administered drugs on a coolie ship, while ghi is given at almost every meal. Stimulants too, may often be required. Hence the risks of accident.

7. That the procedure advocated by Dr. Fonceca has not been shown to be effi- cient is demonstrated by the Committee's Analysis of the Statistics for 1908 fur- nished by Mr. Duff (vide our Committee's letter (paragraph 10)).

8. As to the difficulties of carrying out this procedure, we would draw attention to paragraphs 15 and 16 of our Committee's letter, where they have tried to give some idea of the special conditions on board ship and of how much these differ from those found on shore.

9. When one has been accustomed, under certain conditions, to carry out with apparent ease a given procedure, it is difficult to realise the objections which may exist to applying that procedure under different circumstances, especially if one has no personal experience of these conditions. An example of this was given when the authorities of British Guiana wished to have the thymol treatment carried out in the Calcutta depôt. The Emigration Agent and others connected with the work there at once protested and on such good grounds that the procedure was abandoned. 10. That we are not alone in thinking that it is impracticable to effectually treat coolies for ankylostomes on board ship may be seen by the following extracts from the reports of two eminent medical authorities who were advising the Govern- ment of India as to the treatment of ankylostomes in the depôt at Calcutta.

The Sanitary Commissioner with the Government of India states:-

"I entirely agree with the Surgeons-Superintendent that treatment on board ship is impracticable." See page 2, paragraph 3, of Report marked J & P/4853, 1911, copy of which we send herewith.

The Acting Protector of Emigrants, who is also Port Medical Officer at Calcutta states:- As to the treatment on board ship, it is admitted that the difficulties of medical treatment on a crowded ship are such as to render systematic prophylaxis impossible. I have consulted the medical Inspector, the Agent of the Crown Agents for the Colonies and several Surgeons-Superintendent and I find that they agree with the view above stated."

These statements are all the more important in that they were made by the official advisers to the Government of India, whose rules govern the condition of the Indian emigrants at sea. We would also draw attention to the report J & P 4853, 1911, page 3, where, under the heading " Treatment," the experience of the Natal authorities is referred to by the medical inspector of emigrants at Madras. He states "the treatment, to be effectual, is rather nasty, drastic and rigorous. Treat- ment on board ship was also tried by the Natal authorities and was found to be quite impracticable. Hence it was given up." In the same paragraph he describes the method which the Natal authorities had found to be satisfactory.

11. We have not thought it necessary to furnish a separate report in regard to Jamaica, as what we have stated in regard to British Guiana will for practical pur- poses apply to Jamaica also.

We wish however, to state that we have received no dåta to prove that treat- ment had been successful on the "Indus." The Surgeon reports

46 some were treated a second time successfully, others without success." It is to be remembered that an examination which gives negative results does not prove the patient free of the ankylostomes. Thus he had positive failures, while it is very doubtful whether the cases which he regarded as cured were really so even after the second course of treatment.

12. We find ourselves unable to agree with the deductions expressed by Dr. Neish in his report that the improvement which occurred in the coolies ex "Indus" during their stay in quarantine station was due wholly or even chiefly to thymol treatment. 13. A coolie, in regard to his physique, usually passes after embarkation through certain well known stages. At first he falls off owing to sea-sickness, fretting for home, lack of exercise owing to confined space, &c. Later he improves, appetite returns, he begins to accumulate energy, custom and discipline have taught him to

• Not reprinted.

83391

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Page 540Page 541

PUBLIC RECORD OFFICE

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Reference :-

C.O. 8

885

21 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

212

coolie ships with either or both of these They are unable to affirm that the treat- drugs?

ment would be effective. They would suggest that the cases requiring treat- ment should be selected in the Calcutta depôts, by the depôt staff, previous to embarkation, and a list supplied to the surgeon. They would then endeavour to treat as many as possible during the voyage. They believe that it would not be necessary to employ a medically quali- fied man to make the examinations in the depôts. A native compounder with a knowledge of microscopic work would be sufficient.

I have, &c.,

Enclosure 2 in No. 130.

W. K. MILEY,

Hon. Secretary.

Note. For convenience of reference we have made at the end of this letter a summary of its contents.

GENTLEMEN,

London, June, 1913.

The meeting has asked me the Honorary Secretary to convey to you the results of its consideration of this question, and this I have now the honour of doing. 2. We (the Surgeons-Superintendent) gave careful consideration to those papers but could find no cause in them for altering our previously expressed opinion

that it is inexpedient to apply compulsory routine treatment on coolie ships.

Now that the question has been revived, and as that letter bears on it, we beg to forward it herewith.

4. We would direct special attention to the following points connected with this question:-

(a) the risks involved in compulsory indiscriminate treatment;

(b) the absence of proof of the efficiency of such treatment on board ship;

5. In our Committee's letter these points are dealt with at some length; but

In all cases the patient should be carefully examined as to the condition of his organs before treatment is begun and he should be placed on low or liquid diet for a day or so and while being treated should be kept in bed thymol is a very poisonous drug in large doses, causing first irritation of the cerebral centres with excitement and vertigo. larger doses, the nerve centres are paralysed, blood pressure falls and the In patient dies of collapse. Thymol is very insoluble in water, but easily soluble in alcohol, ether, chloroform, glycerine and turpentine; hence no stimulant

213

whatever must be given to a patient who is to take or who has taken thymol Thymol is also soluble in oil; hence no purgative of castor oil should be given after its administration

beta naphthol can be given in 15 grain doses in the same manner as thymol same precautions as with thymol."

with the

Now castor oil is one of the most useful and most frequently administered drugs on a coolie ship, while ghi is given at almost every meal. Stimulants too, may often be required. Hence the risks of accident.

That the procedure advocated by Dr. Fonceca has not been shown to be effi- cient is demonstrated by the Committee's Analysis of the Statistics for 1908 fur- nished by Mr. Duff (vide our Committee's letter (paragraph 10)).

As to the difficulties of carrying out this procedure, we would draw attention to paragraphs 15 and 16 of our Committee's letter, where they have tried to give some idea of the special conditions on board ship and of how much these differ from those found on shore.

An example of this was given when the authorities of British Guiana wished to have the thymol treatment carried out in the Calcutta depôt. The Emigration Agent and others connected with the work there at once protested and on such good grounds that the procedure was abandoned. 10. That we are not alone in thinking that it is impracticable to effectually treat coolies for ankylostomes on board ship may be seen by the following extracts from the reports of two eminent medical authorities who were advising the Govern- ment of India as to the treatment of ankylostomes in the depôt at Calcutta.

The Sanitary Commissioner with the Government of India states :-

I entirely agree with the Surgeons-Superintendent that treatment on board ship is impracticable." See page 2, paragraph 3, of Report marked J & P/4853, 1911, copy of which we send herewith.

The Acting Protector of Emigrants, who is also Port Medical Officer at Calcutta states: As to the treatment on board ship, it is admitted that the difficulties of medical treatment on a crowded ship are such as to render systematic prophylaxis impossible. I have consulted the medical Inspector, the Agent of the Crown Agents for the Colonies and several Surgeons-Superintendent and I find that they agree with the view above stated."

These statements are all the more important in that they were made by the official advisers to the Government of India, whose rules govern the condition of the Indian emigrants at sea. We would also draw attention to the report J & P 4853, 1911, page 3, where, under the heading "Treatment," the experience of the Natal authorities is referred to by the medical inspector of emigrants at Madras. He states the treatment, to be effectual, is rather nasty, drastic and rigorous. Treat- ment on board ship was also tried by the Natal authorities and was found to be quite impracticable. Hence it was given up." In the same paragraph he describes the method which the Natal authorities had found to be satisfactory.

11.

We have not thought it necessary to furnish a separate report in regard to Jamaica, as what we have stated in regard to British Guiana will for practical pur- poses apply to Jamaica also.

We wish however, to state that we have received no data to prove that treat- ment had been successful on the "Indus." The Surgeon reports

24 some were treated a second time successfully, others without success.' It is to be remembered that an examination which gives negative results does not prove the patient free of the ankylostomes. Thus he had positive failures, while it is very doubtful whether the cases which he regarded as cured were really so even after the second course of treatment.

• Not reprinted.

83391

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